It’s Black Maternal Health Week, and the Leapfrog Group’s 2025 Maternity Report clarifies that Black women still face significant gaps in maternity care. Hospitals have been trying to cut back on unnecessary C-sections for years, but progress has stalled. The national rate for low-risk first-time mothers was 26.4% in 2015, and nearly a decade later, it’s barely moved, sitting at 25.3%. These are statistics that we can’t ignore.
What the Report Tells Us
According to the report, one in five hospitals reports racial disparities in C-section rates, particularly between Black and white patients. This points to deeper systemic issues. Some hospitals also lack clear policies to prevent early elective deliveries, which can lead to postpartum complications for moms and health risks for babies.
Access to certified midwives and doulas remains uneven across the country, with significant gaps in certain regions. Where you give birth matters. Outcomes often rely on the hospital’s culture and policies, making it critical for families to research, ask questions, and advocate for themselves.
To explore these issues further, we turned to two leaders driving progress in maternity care, Katie Stewart, Director of Health Care Ratings at The Leapfrog Group, and LaToshia Rouse, Certified Doula and founder of Birth Sisters Doula Services.
Katie Stewart on Maternal Care Improvements
Katie Stewart leads efforts to bring transparency to healthcare systems. With a deep commitment to improving safety and quality, she has advocated for using public reporting to drive change in maternity care.
BHM: Katie, what sets Leapfrog apart regarding maternity care?
Katie Stewart: It’s all about showing the numbers. When Leapfrog started publicly reporting hospital data, it was a big deal. There wasn’t much transparency back then. Today, hospitals use our information to set benchmarks and drive real change.
Look at episiotomies. Since we started tracking them in 2012, rates have dropped by 73%. Those are thousands of women whose experiences were made safer and healthier because hospitals stepped up.
BHM: Progress on cutting unnecessary C-sections has stalled since 2020. What’s holding things back?
Katie Stewart: Research shows that the most significant factor in whether or not a patient will have a C-section is the hospital where they give birth. The culture of the hospital, as well as its architectural design, plays a significant role in shaping C-section rates. Leading up to 2020, we were seeing progress in reducing C-section rates for low-risk, first-time mothers. Transparency has been a powerful driver of that change, and we’ve seen it work before. We’re hopeful it will work again to bring down unnecessary C-section rates.
BHM: One in five hospitals has racial disparities in C-section rates. What’s the solution?
Katie Stewart: Leapfrog started collecting this data last year, and we plan to report it publicly, by hospital, in the future. Transparency is the foundation of progress, and you cannot change what you don’t measure.
In addition, Leapfrog has included a health equity measure in another part of the Hospital Survey to ensure all patients receive safe, high-quality care. Hospitals must analyze their own data to uncover any disparities in outcomes or processes based on race, ethnicity, or language. The measure looks at whether hospitals are doing the following: collecting patient data on race, ethnicity, and language preferences; training staff to gather this information directly; stratifying at least one quality measure to identify disparities; and, if disparities are found, taking action to fix them.
Hospitals are also encouraged to share their progress publicly and report their equity efforts to their boards. By highlighting these differences, Leapfrog aims to galvanize meaningful change in healthcare delivery.
For example, last year, The New York Times did a story called “Doctors Give Black Women Unneeded C-Sections Study Suggests,” which features authors of a study who examined medical records of Black women and white women who were healthy and had low risk factors in New Jersey. Of the nearly one million births they reviewed, the researchers found that Black women were 20% more likely to have their baby via C-section, particularly if an operating room was empty.
A Voice from the Front Lines
LaToshia Rouse is a Certified Doula and the founder of Birth Sisters Doula Services. She directly supports Black families through her work, empowering them during pregnancy and childbirth. She also advocates for equitable maternity care and helps bridge the gap between hospitals and the communities they serve.
BHM: The report highlights disparities in maternal care outcomes for Black mothers. As a doula, what do you observe in your work?
LaToshia Rouse: As a doula, I see firsthand how Black patients are often not believed, not listened to, or have their concerns minimized. They’re more likely to face dismissive attitudes, have their pain downplayed, or experience delays in treatment. There’s also a pattern of being excluded from important conversations about their care.
Hospitals can start to change this by embedding respectful care training into every aspect of practice, adopting shared decision-making models, and investing in community feedback to help shape their policies.
Representation is critical, but so is accountability. Equity is not just a checklist, and it isn’t free; it requires a cultural shift that centers the patient’s voice, ensures transparency, and partners with doulas to offer the support patients need.
BHM: Nearly 90% of hospitals allow doulas, but few employ them directly. What are the benefits of expanding direct access to doulas within hospitals, and how do you see this change impacting outcomes for Black mothers in particular?
LaToshia Rouse: I think doulas need to be a partner to a hospital, but not employed by hospitals. They could be independent contractors who provide the support they were trained to provide to their community while maintaining their autonomy. This is because the system has a culture. Culture will eat away at anything it is introduced to and cause it to conform.
Hospitals can include doulas as a part of their care package and pay the doula directly as long as the doula maintains their autonomy.
Direct access to doulas through hospitals removes barriers like cost, confusion around policy, and can be a bridge to awareness of doula support. It helps ensure that every person giving birth, especially those at higher risk of poor outcomes, can benefit from continuous, culturally aligned support.
Doulas are proven to reduce cesarean section frequency, low birth weight, and premature labor. Additionally, we improve other outcomes such as breastfeeding and mental health.
BHM: How can Black families better advocate for themselves within a hospital system, and what role can doulas play in making the process feel less intimidating and more empowering?
LaToshia Rouse: Black families can start by knowing their rights, asking questions, saying no to interventions, and insisting on being fully informed. I teach families to use their B.R.A.I.N. They need to know the Benefits, Risks, and Alternatives. What does your Intuition say? What happens if we don’t do this now or not at all? This gives families the information they need to make informed decisions.
We help them develop a written birth plan that the medical team can discuss in advance. We also hold space emotionally so families can focus on their experience, not just navigating the system.
That confidence and preparation can transform fear into power, and doulas are often the catalyst for that shift.
BHM: What are some misconceptions about doulas’ roles in maternity care, and how do you break down those barriers to establish trust with medical teams?
LaToshia Rouse: One common misconception is that doulas are anti-medical or there to challenge clinicians and nurses. In reality, most of us are collaborators, and we want to work with them to make this a healthy, memorable experience for the family. We’re there to support the person giving birth and to help the team work more smoothly.
Another myth is that we give medical advice. We educate, comfort, and advocate with information commonly shared in childbirth education. To break down barriers, I introduce myself to staff early, clarify my role, and stay solution-oriented.
I also help the nurses by updating them on what happened when they left out, and I maintain calm when they cannot. We get the mom up and moving around to aid in faster labor. When care teams see that I respect their expertise and am there to enhance support and not disrupt their care, trust starts to build. The best outcomes happen when everyone sees each other as part of the same team.
Black Maternal Health Week reminds us to reflect on the strength of Black mothers and the families they nurture. It’s a chance to recognize the disparities they face and recommit to the work it takes to eliminate them. Every mother should feel supported, respected, and safe during childbirth. By continuing to center our communities in this conversation, we can strive for maternity care that consistently and compassionately serves everyone.
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